4. Crossword helper (3 letters)

February 27, 2007 - Yesterday, The New York Times Crossword Puzzle included the following as the fourth of its "Down" clues: "I.C.U. helpers." We thought: "Hmm. That's not an accurate or sensitive way to describe the skilled physicians who work with the elite nurses who play the central role in keeping critical patients alive. This is the premiere crossword puzzle in the world!" Imagine our shock when we discovered (and today's published solution confirmed) that the "correct" answer was in fact "RNS." OK, we're joking. Of course we knew instantly that the answer involved nurses, and that the Times puzzle's place in the cultural landscape was irrelevant, since ignorance of nursing's true value is endemic in all segments of global society. The puzzle was created by Peter A. Collins, and edited by puzzle superstar Will Shortz. Incidentally, the answer to the clue heading this analysis is "NYT."

See the crossword puzzle below.

The nurse / crossword solver who brought this to our attention noted that a 3-letter answer to 4 Down could just as easily have been "DRS," though that would not have fit with the surrounding answers. Indeed, some might suggest that if one were forced to diminish one of the two well-known groups of intensive care professionals with the term "helpers," it would more logically be physicians. Perhaps that would have been a clue for the tougher Thursday puzzle, since it would take far more knowledge of hospital operations to come up with that distortion of reality.

Nurses autonomously monitor ICU patients 24/7 using the most advanced technology, coordinate the wide range of treatments these patients require, provide key education and psychosocial support to families, and consult with physicians about care plans. There is typically one nurse for every 1-2 ICU patients at all times. The main physician role of checking on the progress of care plans and making needed modifications is an important one. But no careful, unbiased observer of the ICU could conclude that nurses are there to "help" physicians.

It is possible to interpret the puzzle clue as suggesting that ICU nurses "help" the patients. But we doubt many will understand it that way. And that would still be a dismissive way to summarize what the college-educated science professionals who practice ICU nursing do to keep patients alive. ICU "experts," "key players" or "guardians" would be closer to the mark.

Of course, to describe ICU nurses as "helpers" is fully consistent with the prevailing media conception of their work, particularly that displayed on influential prime time television dramas such as ABC's "Grey's Anatomy" and NBC's "ER." Such shows typically portray physicians as the main force in ICU care, while nurses are seen as subordinate clerks--yes, "helpers"--when they are present at all. Such messages are not lost on society (including its puzzle creators) simply because the messages are embedded in entertainment television, as public health research confirms. And prominent crossword puzzles will clearly have a similar effect.

We encourage Mr. Shortz and his helpers to make amends for this clue by running many others that reflect the central, expert role skilled nurses actually play in patient outcomes.

Please write a letter to Will Shortz and tell him exactly what nurses do to save lives and improve patient outcomes and why they deserve the clue "ICU experts." Please send us your letter at letters@nursingadvocacy.org--we will snail mail your letters to Will Shortz and the NYT Ombudsman at the following addresses unless you tell us that you have done so already. Thank you!

Mr. Will Shortz
Crossword Puzzle Editor
The New York Times
229 West 43rd St.
New York, NY 10036-3959

Mr. Byron Calame
Public Editor
The New York Times
229 West 43rd St.
New York, NY 10036-3959

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